Journal of Acuherb in Medicine


Asthma

Print Friendly

 Asthma

 

Asthma is classified, in Traditional Chinese Medicine (TCM), as wheezing and/or panting syndromes. It was first described in the ancient medical book Summary of the Golden Chamber. Asthma was mentioned as a kind of “cough resulting from the ascending movement of qi (panting).” A narrowed airway caused a whistling sound during breathing, which was described as a “chicken sound in the throat.” Another medical book, Treatise on the Causes and Symptoms of Disease (610 AD), also pointed out other asthma characteristics such as its “regular recurrence” in individuals. 

Although both of these syndromes are associated with asthma in western medicine, they have distinct differences. The Chinese term for wheezing is “xiao.” A wheezing syndrome is characterized by congestion with phlegm (bronchial secretions) and gasping which produces a whistling sound in the “throat.” (The word “throat ” refers to the whole respiratory tract). It also is associated with rapid breathing and shortness of breath. In severe cases, these symptoms cause difficulty lying down. 

The Chinese term for panting is “chuan.” A panting syndrome is characterized by rapid breathing, an open mouth, dyspnea (difficulty breathing) and elevated shoulders. Elevated shoulders occur when individuals have persistent difficulty breathing and need to use their shoulder muscles in addition to their chest muscles to support respiration. In western medicine, this is referred to as the use of accessory breathing muscles. 

Wheezing and panting syndromes can occur simultaneously or alone. TCM treats asthma according to the classification patterns and symptoms the individual exhibits.

Causes

Asthma presents as a wheezing and/or panting syndrome.

Wheezing syndromes are caused by: 

1. Pernicious evils (environmental factors leading to illness). These include wind, summer heat, dampness, dryness, cold and fire.
2. Improper diet
3. Emotional disturbance
4. Stagnation of liver qi (When the liver is healthy, it maintains the smooth movement of qi though its flowing and spreading functions.)

These factors impair the organs, (lungspleen and kidneys), responsible for fluid metabolism. As a result, an accumulation of unhealthy dampness in the body, known as “phlegm,” occurs. Obstruction of the airways develops when phlegm rises with qi. Phlegm also hinders the movement of qi. When this happens, the lungs cannot descend and disseminate qi properly. As a result, the airway will narrow and phlegm and qi will fight each other, producing a wheezing or whistling sound in the throat.

Panting syndromes are mostly caused by lung and kidney disharmony.

Normally, the lungs descend and disseminate the different types of qi to the rest of the body. If lung disharmony is present, panting will occur. There are several reasons for this: 

1. The attack of wind-heat or wind-cold (two types of pernicious evils) leads to a problem with regulating sweat. Normal sweat regulation is important for the healthy dissemination of lung qi.
2. Spleen disharmony causes problems with the body’s digestive functions and results in an accumulation of dampness or “phlegm.” When the phlegm is sent upwards to the lungs, it affects their normal descending properties.
3. Emotional disturbance
4. Emotional disorders lead to either stagnation of qi or liver disharmony. As the lungs rule qi, and the liver rules the flowing and spreading of qi, any stagnation will cause disharmony of lung function.

Kidney disharmony also plays a role in panting syndromes. The kidneys rule the grasping of qi (the regulation of healthy inhalation), and the lungs rule qi (regulation of breathing). A deficiency in either the lungs or kidneys can lead to a panting syndrome. 

Symptoms

Asthma symptoms are grouped into different classification patterns depending on their manifestations.

Exacerbation period 
During an exacerbation of asthma, two different clinical patterns can present. These are the cold and heat types. Cold and heat influences are either environmental or physiological factors that trigger the exacerbation. They both belong to the “pernicious evils” in TCM.

1.Cold type asthma 
Cold influences cause stasis (a condition where the flow of a substance is either slowed down or stopped), just as oil becomes viscous (thick) when its temperature is lowered. When a cold influence affects the body, phlegm turns white, thick and sticky, and it is not easily loosened with a cough. Cold phlegm has stasis properties, which lead to chest congestion and obstruction of qi movement and breathing. This results in wheezing and a feeling of chest tightness and fullness. Lastly, the lungs lose their ability to descend and disseminate qi properly. 

Phlegm is a manifestation of an excessive yin pattern. (Yin is usually used to describe material things.) An accumulation of phlegm leads to an imbalance, which results in an excess of yin and a relative deficiency of yang. This causes a dim and bluish complexion, cold limbs, an aversion to cold temperatures, and a preference for warm drinks. Individuals may only sweat a small amount because the cold symptoms are unable to escape to the exterior of the body. People with cold type asthma have a white and greasy or white and slippery tongue coating and a floating, tight pulse.

2.Heat type asthma 
Heat influences have “excitation” properties which manifest as excessive yang patterns. They produce yellow, sticky and thick phlegm and coarse breathing. As lung qi is reversed from its normal descending flow, a paroxysmal cough and a roaring wheezing sound occur because of an accumulation of “heat phlegm.” With the flare up of “heat phlegm,” individuals also experience chest discomfort and thirst. People with heat type asthma have a red face and a red tongue with a yellow, greasy coating. The pulse usually feels slippery and rapid. 

Non-exacerbation period 
During a non-exacerbation period, the symptoms of asthma can be classified into deficiencies of the lungsspleen and kidneysor any combination of these.

1.Deficiency of lungs
Normal lung function affects the health of some exterior body parts such as the hair, skin and sweat glands. If the exterior is weak and lacks sufficient support from protective qi, (a type of qi which acts like the immune system), the body is easily attacked by the “pernicious evils” (environmental factors which cause illness). With weakened lung qi, spontaneous sweating and an aversion to wind occur. Because the lungs open into the nose, individuals may experience sneezing and nasal congestion with a clear discharge. Deficient lungs cannot properly rule qi, which leads to symptoms of shallow breathing and a cough with thin, white sputum. Individuals with a lung deficiency look pale and have a tongue with a thin white covering. A thin and weak pulse is felt upon palpation.

2.Deficiency of spleen 
The spleen is an essential organ in TCM. It is responsible for digestion and transforming food into food essence, which is in turn transported to the lungs and distributed to the rest of the body. A spleen deficiency can cause asthma, because when it is unable to transform fluids, phlegm accumulates. People with a spleen deficiency have poor appetites and can develop epigastric (stomach region) problems, loose stools or even diarrhea. The spleen is also essential for production of qi and blood and rules the limbs. A deficiency can cause fatigue, shortness of breath and a low voice. A pale tongue with a thin, greasy or white, slippery coating and a thin, soft pulse are the usual signs of spleen deficiency.

3.Deficiency of kidneys 
The kidneys rule the grasping of qi, which is responsible for healthy, deep inhalation when breathing. If there is a kidney deficiency, qi is said to be unable to return to its origin, (the kidney region), and shallow breathing occurs. The shallow breathing becomes worse on exertion and leads to wheezing or shortness of breath. The kidneys also rule the bone and are responsible for producing bone marrow. Soreness and weakness of the waist and legs and insufficient nourishment of the brain causing ringing in the ears are other symptoms that can occur with a kidney deficiency. If the kidney deficiency belongs to a yang deficiency, individuals have cold limbs and an aversion to cold, but if the deficiency belongs to a yin deficiency, individuals have red cheeks, night sweats and afternoon hot flashes.

Diagnosis

Differentiation between chronic cough and asthma
Asthma or wheezing/panting syndrome is associated with episodes of remission and serious exacerbations, whereas a chronic cough is persistent and does not go away. They can be further differentiated by the characteristics of the cough. With a chronic cough, the coughing sound is usually stronger than the wheezing sound. With asthma, the reverse is true. In general, the wheezing sound is stronger.

Differential classification of disharmony patterns 
Asthma belongs to a disharmony pattern featuring both excessive pernicious evils and deficient normal qi. Mainly an excess of pernicious evils, (environmental factors that cause illness) causes exacerbations of asthma. This type of asthma is associated with coarse breathing and a high-pitched wheezing sound. Each breath is long and deep with a rapid expiration time. The pulse is strong, and generally, the body is not in a weak state. 

The non-exacerbation period is related to a deficiency of normal qi. Asthma due to deficient normal qi is associated with weak breathing and a low wheezing sound. The breath is short and not smooth. There is usually a long history of asthma, where the individual experiences difficulty with inspiration. This deficient-type of asthma is associated with a sinking and weak pulse or a thin and rapid pulse .

After differentiating between an excessive evil type and a deficient normal qi type, it is also necessary to distinguish the type of phlegm (hot or cold) and identify the disharmonious organs. Details of the corresponding symptoms are listed under the “Symptoms Section”. 

The major disharmony patterns of asthma are as follows: 

Exacerbation: 
1. Cold type asthma 
2. Heat type asthma 

Non-exacerbation: 
1. Lung Deficiency 
2. Spleen Deficiency
3. Kidney Deficiency

Treatment

The TCM treatment strategy for asthma is based on the diagnosed disharmony patterns.

Cold type asthma 
This type of asthma is caused by the cold evils, the therapeutic aim is to remove the cold evils by warming the lungs. In addition, this decoction helps remove the phlegm and relieve the wheezing.

Decoction examples:
Shegan mahuang decoction

She gan (Blackberrylily Rhizome)
Ma huang (Ephedra)
Gan Jiang (Zingibier or dried ginger)
Xi xin (Manchurian Wild Ginger)
Ban xia (Pinella Tuber)
Zi wan (Tartarian Aster Root)
Kuan dong hua (Common Coltsfoot Flower)
Gan cao (Liquorice Root)
Wu wei zi (Chinese Magnoliavine Fruit)
Da zao (Chinese Date)

In this decoction, She gan and ma huang are responsible for relieving the cough and wheeze, easing the throat and removing the phlegm. Gan jiang, xi xin and ban xia warm the cold phlegm in the lung and reverse the movement of qi. Zi wan, kwuan dong hua and gan cao relieve the cough and remove the phlegm. Wu wei zi stops the lung qi from traveling in the wrong direction and relieves the cough. Da zao helps support the normal qi in the body.

Other related patterns
Wind-Cold tightens the lungs
Wind-cold is an exterior syndrome because it is a pernicious evil which attacks the body from the outside first. The therapeutic goal is to relieve this exterior syndrome with herbs, which are pungent in flavor and warm in property. This helps the lungs to resume their dissemination of qi and provides relief of the asthma symptoms. 

Decoction Example 
Modified powder of huagai 

Ma huang (Ephedra)
Xing ren (Bitter Apricot Seed)
Gan cao (Liquorice Root)
Su zi (Perilla Fruit)
San bai pi (White Mulberry root-bark)
Chen pi (Dried Tangerine Peel)

Heat type asthma
Because this type of asthma is caused by heat evils, the therapeutic goal is to clear away the heat and resume the dissemination of lung qi. Treatment will also remove phlegm and relieve coughing.

Decoction Example 
Ding chuan decoction 

Ma huang (Ephedra)
Huang qin (Baical Skullcap Root)
San bai pi (White Mulberry Root-Bark)
Xing ren (Bitter Apricot Seed)
Ban xia (Pinella Tuber)
Kuan dong hua (Common Coltsfoot Flower)
Su zi (Perilla Fruit)
Bai guo (Ginkgo Seed)
Gan cao (Liquorice Root)

In this decoction, ma huang restores the lungs’ ability to disseminate qi. Huang qin and san bai pi clear away the heat in the lung and restore the liquefying function of the lungs. Xin ren, ban xia, kuan dong and su zi remove the phlegm and redirect qi’s movement to descend. Bai guo arrests lung qi. Gan cao keeps the other herbs in balance and supports the body’s normal qi.

Other related patterns 
Heat retention in lungs 
The therapeutic aim is to clear away lung heat and remove phlegm.

Decoction Examples 
Maxing shigan decoction with modification

Ma huang (Ephedra)
Xing ren (Bitter Apricot Seed)
Shi gao (Gypsum)
Gan cao (Liquorice Root)
San bai pi (White Mulberry Root-Bark)
Huang qin (Baical Skullcap Root)
Chuan Bei mu (Tendrilleaf Fritillary Bulb)

Stagnation of phlegm dampness in middle warmer(spleen and stomach) 
The therapeutic goal to expel the phlegm and support the qi descending function of the lungs. This decoction also helps relieve wheezing. 

Example decoction 
Daotan decoction combined with sanzi yangqin decoction 

Dan nan xing (Bile Arisaema)
Zhi shi (Immature Orange Fruit)
Ban xia (Pinella Tuber)
Chen pi (Dried Tangerine Peel)
Fu ling (Indian Bread or Poiria)
Gan cao (Liquorice Root)
Bai jie zi (Mustard Seed)
Su zi (Perilla Fruit)
Lai fu zi (Radish Seed)

Lung Deficiency
The lungs are responsible for governing the health of protective qi, which is part of our immunity. When lung disharmony occurs the aim is to restore normal lung function and consolidate the exterior and protective qi in the body so illness can be avoided 

Decoction examples 
Yu ping feng powder 

Huang qi (Milkvetch Root or Astragalus)
Bai zhu (Largehead Atractylodes Rhizome)
Fang feng (Divaricate Saposhnikovia Root)

In this decoction, huang qi and bai zhu support qi and consolidate the exterior. Fang feng also helps support exterior consolidation and in addition removes wind evils. Wind evils usually attack the lungs when the exterior of the body is weak.

Shengmai decoction and erchen decoction with modifications 

Ren shen (Panax Ginseng)
Mai dong (Dwarf Lilyturf Tuber)
Wu wei zi (Chinese Magnoliavine Fruit)
Huang qi (Milkvetch Root or Astragalus)
Ban xia (Pinella Tuber)
Ju hong (Red Tangerine Peel)
Fu ling (Indian Bread or Poiria)
Gan cao (Liquorice Root)
Zi wan (Tartarian Aster Root)

This is another example of a decoction used to restore lung function.

Spleen Deficiency
The spleen is responsible for transforming fluids into substances that are essential to maintain health. Therefore, in order to restore the healthy balance of the spleen, it is necessary to support the spleen’s transformation function and remove the excess unhealthy fluids known as phlegm. 

Decoction example 
Liu junzi decoction 

Dang shen (Tangshen or Radix Codonopsis)
Bai zhu (Largehead Atractylodes Rhizome)
Fu ling (Indian Bread or Poiria)
Gan cao (Liquorice Root)
Chen pi (Dried Tangerine Peel)
Ban xia (Pinella Tuber)

In this decoction, dang shen, bai zhu, fu lin and gan zao are excellent combination herbs for strengthening the spleen and replenishing qi. Chen pi and ban xia are good for removing phlegm and regulating qi. All the herbs in this combination work together to support the spleen’s transformation function. 

Kidney Deficiency 
The kidneys also play an important role in regulating healthy breathing. Therefore, the treatment goal is to replenish the kidneys and support their qi grasping function so healthy breathing can be resumed.

Decoction example 
Jingui shengqi pill 

Di huang(dry) or sheng di (Rehmannia Root)
Shan zhu yu (Asiatic Cornelian Cherry Fruit)
Shan yao (Common Yam Rhizome)
Fu ling (Indian Bread or Poiria)
Ze xie (Oriental Waterplantain Rhizome)
Mu dan pi (Tree Peony Bark)
Gui zhi (Cassia Twig)
Fu zi (Prepared Common Monkshod Daughter Root)

This is a famous decoction for supporting kidney yang. Di huang is good herb for nourishing the kidney yin. It is usually supported by sha zhu yu and shan yao which enhance the spleen’s functions. As di huang has certain wet properties, ze xie is added to remove the excessive fluids and regulate the fluid channels. Fu lin helps support the spleen and transform fluids. Dan pi releases and clears away liver fire resulting from deficient heat. After this, fu zi and gui zhi are added to support the kidney yang. Fu zi helps replenish the yang and dispels the cold while gui zhi warms the meridian so there can be smooth movement of fluids inside the blood vessels.

Other related patterns 
Yin difficiency of lungs and kidneys 
The therapeutic aim is to nourish the yin and keep the yang in its original place without overwhelming other organs.

Decoction example 
Liuwei dihuang decoction combined with shengmai decoction 

Sheng dior di huang (Rehmannia Root)
Shan zhu yu (Asiatic Cornelian Cherry Fruit)
Shan yao (Common Yam Rhizome)
Mu dan pi (Tree Peony Bark)
Fu ling (Indian Bread or Poiria)
Ze xie (Oriental Waterplantain Rhizome)
Tai zi shen (Heterophylly Falsestarwort root)
Mai dong (Dwarf Lilyturf Tuber)
Wu wei zi (Chinese Magnoliavine Fruit)

 

 Prevention

Prevention is essential for maintaining the health of asthma patients. The following issues should be remembered:

1. Pay attention to changes in the weather; because, they can trigger asthma exacerbations.
2. Pay attention to environmental influences such as the pernicious evils, which cause illness. 
3. Keep healthy and avoid getting a cold or the flu.
4. Avoid smoking and keep away from other stimulating substances cause asthma exacerbations such as smoke and pollens.
5. Stay on a simple, healthy diet. Avoid eating raw, cold, greasy or pungent food. Also avoid eating shrimps or crabs.
6. Get adequate rest. Avoid exhaustion and mental stress because they can trigger asthma.
7. Exercise daily to keep your body healthy and strong.

References

1. Beijing University of Traditional Chinese Medicine: Traditional Chinese Internal Medicine, Academy Press, (2000).
2. Guang Anmen Hospital (Traditional Chinese Medicine Institute of China): The Diagnosis and Treatment Principle of TCM, Publishing House of Ancient Books of TCM, (1989).
3. Kelly, William N. Textbook of Internal Medicine,3rd Edition, Philadelphia & New York: Lippincott-Raven, (1997).
4. National Institutes of Health, Expert Panel Report 2:Guidelines for the Diagnosis and Management of Asthma, NIH publication No.97-4051, April 1997
5. Zhang Enqin, Clinic of Traditional Chinese Medicine (I), Publishing House of Shanghai College of TCM, (1990).
6. 張伯臾等:《中醫內科學》,上海 上海科學技術出版社,(1993)。

Post a Comment

You must be logged in to post a comment.